RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04369
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Forward Observer-Field Artillery, medically separated for “illioinguinal neuralgia…left groin,” with a disability rating of 0%.

CI CONTENTION:  The CI requests consideration of all conditions.  The CI’s complete submission is at Exhibit A.   

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:

Service IPEB – Dated 20081022	VARD – 20120503/20120912*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ilioinguinal Neuralgia…Left Groin	8730	0%	Postsurgical Left Orchalgia S/P Hydrocelectomy…	7523	0%*	20120206	
Ankle and Knee Pain	Not Unfitting	Right Ankle Sprain	5271	NSC	20120206	
		Right Knee DJD	5242	NSC	20120206	
ADHD	Not Unfitting	PTSD	9411	30%	20120202	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Groin (Ilioinguinal Neuralgia).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin problem began prior to enlistment in 2003 after he was hit with a basketball.  The pain resolved but swelling in the left groin (hydrocele) remained and the pain recurred after increased physical activity in July 2007.  The CI underwent surgery for removal of the hydrocele while deployed and did well until he was re-injured in December 2007.  He was medically evacuated and was treated with multiple courses of antibiotics and anti-inflammatory medications.  He was evaluated by an urologist and was diagnosed with epididymitis and a varicocele.  He was offered surgery or a nerve block of the ilioinguinal nerve, but declined both due to fertility concerns.  The MEB forwarded “post-surgical state with chronic pain syndrome” for PEB adjudication.  

The MEB NARSUM examination on 7 August 2008, 6 months prior to separation, noted complaints of groin pain.  The listed medications included an antidepressant and pain medication. On physical examination of the left groin there was a palpable varicocele (enlargement of veins in testes) with swelling and moderate to severe tenderness without warmth or redness.  Notes in record post-separation to December 2008 noted the CI continued to report groin pain aggravated by activity.  He was taking pain medication as needed and an antidepressant daily for chronic pain management for the groin condition.  In December 2008 the CI noted some days he did not need to take the pain medication at all and other days he took two or three doses.  There was no VA Compensation and Pension (C&P) evaluation performed within 12 months of separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin condition 0%, coded 8730 (ilioinguinal nerve), citing severe chronic groin pain.  The original VA Rating Decision (VARD) did not address the left groin condition.  The VARD dated 12 September 2012 rated the left groin condition 0%, coded 7523 (testis, atrophy complete) with an effective date of 22 May 2012.  The Board agreed that coded IAW VASRD 4.124a (neurological conditions), no higher than a 0% rating was supported under 8730 for moderate incomplete paralysis of the ilioinguinal nerve.  VASRD 4.124 (neuralgia) specifies that neuralgia ratings will be rated “with a maximum equal to moderate incomplete paralysis.”  The cause of the CI’s chronic pain status post the urologic procedure in this case was chronic epididymitis and a varicocele.  The Board considered if coding alternatively IAW VASRD §4.115b (genitourinary system system) as analogous to 7525 (chronic epididymo-orchitis, chronic only), which is rated according to criteria for urinary tract infection (UTI), supported a higher rating.  Board consensus was that the disability due to the CI’s chronic epididymitis and varicocele was analogous to the UTI rating criteria of required “long-term drug therapy” for a 10% rating, but did not meet the threshold for the 30% rating which requires frequent procedures or hospitalizations (more than two times/year) or continuous intensive management.  There was therefore no higher than a 10% rating available with any applicable VASRD code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left groin ilioinguinal neuralgia condition, coded 7599-7525.  

Contended PEB Conditions:  Ankle and Knee Pain Conditions and Attention Deficit Hyperactivity Disorder (ADHD).  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  Additionally, ADHD is a condition not constituting a physical disability, IAW DoDI 1332.38.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the ilioinguinal neuralgia condition, the Board unanimously recommends a disability rating of 10%, coded 7599-7525 IAW VASRD §4.115b.  In the matter of the contended ankle and knee pain and attention deficit hyperactivity disorder, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Ilioinguinal Neuralgia	7599-7525	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20160018436 (PD201404369)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA